Provider Demographics
NPI:1184811150
Name:SHORT, DARREN T (RRT)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:T
Last Name:SHORT
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11142 17 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9749
Mailing Address - Country:US
Mailing Address - Phone:269-225-8030
Mailing Address - Fax:
Practice Address - Street 1:11142 17 MILE RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-9749
Practice Address - Country:US
Practice Address - Phone:269-225-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30006893A227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered